| NPI | 1023408564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223S0112X Dentist, Oral and Maxillofacial Surgery (Licence: TX 31884) |
| Additional Taxonomies | 204E00000X Oral & Maxillofacial Surgery (Licence: TX 31884) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2021-06-07 |